<!--<div id="content">-->
<div class="container">
	<div class="row">
		<div class="col-sm-8">
			<a class="navbar-brand navbar-title" href="#">Preview Register</a>
		</div>
	</div>
	<div class="row">
		<div class="col-sm-8">
			<div id="message"></div>
                <?php  echo form_open("end_user/registration"); ?>
            <div class="contact-form">
				<div class="row">
					<div class="col-sm-6">
						<input name="name_show" type="text" disabled id="name" value="<?php echo $name; ?>" 
						class="form-control contact-input" placeholder="Name">
						<input type="hidden" name="name" value="<?php echo $name; ?>">
					</div>
				</div>
				<div class="row">
					<div class="col-sm-6">
						<input name="email_show" type="text" disabled id="email" class="form-control contact-input animate" 
						placeholder="Email" value="<?php echo $email; ?>" />
						<input type="hidden" name="email" value="<?php echo $email; ?>">
					</div>
				</div>
				<div class="row">
					<div class="col-sm-6">
						<label>Tel Number</label> 
							<input name="tel_number1_show" disabled size="4" class="numeric  contact-input animate" 
							type="text" maxlength="4" value="<?php echo $tel_number1; ?>" />- 
							<input name="tel_number2_show" disabled size="4" class="numeric  contact-input animate" 
							type="text" maxlength="4" value="<?php echo $tel_number2; ?>" />- 
							<input name="tel_number3_show" disabled size="4" class="numeric  contact-input animate" 
							type="text" maxlength="4" value="<?php echo $tel_number3; ?>" />
							<input type="hidden" name="tel_number1" value="<?php echo $tel_number1; ?>">
							<input type="hidden" name="tel_number2" value="<?php echo $tel_number2; ?>">
							<input type="hidden" name="tel_number3" value="<?php echo $tel_number3; ?>">
					</div>
				</div>
				<div class="row">
					<div class="col-sm-6">
						<label>Fax Number</label> 
							<input name="fax1_show" disabled size="4" class="numeric  contact-input animate" type="text"
							maxlength="4" value="<?php echo $fax1; ?>" />- 
							<input name="fax2_show" disabled size="4" class="numeric  contact-input animate" type="text" 
							maxlength="4" value="<?php echo $fax2; ?>" />- 
							<input name="fax3_show" disabled size="4" class="numeric  contact-input animate" type="text"
							maxlength="4" value="<?php echo $fax3; ?>" /> 
							<input type="hidden" name="fax1" value="<?php echo $fax1; ?>">
							<input type="hidden" name="fax2" value="<?php echo $fax2; ?>">
							<input type="hidden" name="fax3" value="<?php echo $fax3; ?>">
					</div>
				</div>
				<div class="row">
					<div class="col-sm-12">
                    	<?php foreach ( $get_province as $province ) { ?>
		            	<label for="con_name">Province : 
		            		<input type="text" id="pro_branch" name="pro_name_show" class="form-control contact-input animate" 
		            		disabled value="<?php echo $province->PROVINCE_NAME; ?>" />
		            		<input type="hidden" name="province" value="<?php echo $province->PROVINCE_ID; ?>">
						</label> 
		                 <?php } 
						foreach ( $get_district as $district ) { ?>
		                <label for="con_name">District Branch : 
		                	<input type="text" id="dis_branch" name="dis_name_show" class="form-control contact-input animate" 
		                	disabled value="<?php echo $district->district_NAME; ?>" />
		                	<input type="hidden" name="district" value="<?php echo $district->district_ID; ?>">
		                </label> 
						<?php } ?>
					 </div>
				</div>
				<div class="row">
					<div class="col-sm-6">
						<input type="text" disabled class="form-control contact-input date" name="meet_date_show"
						value="<?php echo $meetdate; ?>" placeholder="Meet Date">
						<input type="hidden" name="meet_date" value="<?php echo $meetdate; ?>">
					</div>
				</div>
				<div class="row">
					<div class="col-sm-12">
						<textarea id="address" disabled rows="10" placeholder="Address" class="form-control contact-textarea" 
						name="address_show"><?php echo $address; ?></textarea>
						<input type="hidden" name="address" value="<?php echo $address; ?>">
					</div>
				</div>
				<div class="row">
					<div class="col-sm-12">
						<div class="pull-left clearfix">
							<button onclick="history.go(-1);" type="button" id="submit" class="submit-btn active-btn">Back</button>
						</div>
						<div class="pull-left clearfix">
							<button type="submit" id="submit" class="submit-btn active-btn">Confirm Submit</button>
						</div>
					</div>
				</div>
			</div>
                 <?php echo form_close(); ?>
            </div>
		<div class="col-sm-4"></div>
	</div>
</div>
